Background: Patients in the immune-tolerant phase of chronic hepatitis B (CHB) infection usually have no or minimal liver disease. This lack of disease activity is the reason why they are not included in most treatment guidelines for CHB. However, recent studies have shown that higher HBV DNA level is independently associated with a higher risk of hepatocellular carcinoma (HCC), irrespective of age, serum ALT or HBeAg status. This has led experts to deliberate liberalising CHB treatment to include those in the immune-tolerant phase.

Aim: To investigate the outcome on liver stiffness and serum ALT levels in immune-tolerant CHB patients above the age of 30 treated with antiviral therapy.

Result: Fifty-three immune-tolerant HBeAg-positive patients were treated with entecavir and followed-up for mean (SD) of 77 (19) months. At the end of follow-up, only two of the 53 patients (3.8%) developed HBeAg seroconversion. There was no significant difference in the liver stiffness at the end of follow-up when compared with pre-treatment liver stiffness (mean 4.5 vs. 5.1 kPa; p=0.165). The mean serum ALT level at the end of follow-up was also not significantly different when compared with pre-treatment level (30 v. 36 U/L, p=0.089).

Conclusion: Anti-HBV therapy in the immune-tolerant group above the age of 30 did not confer any improvement in live stiffness or serum ALT levels. Our data does not support further liberalisation of anti-HBV therapy to CHB patients in the immune-tolerant phase.